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Medical Transportation Claim Submission Updates

August 3, 2016

Effective for dates of service on or after July 1, 2016, prior Medicare denial is not required when submitting claims for the following medical transportation HCPCS codes: A0130, A0225, A0380, A0390, A0420, A0422, A0424, T2001, T2005 and T2007. Providers should bill these codes to Medi-Cal directly.

Affected claims were denied with Remittance Advice Details (RAD) code 0012: Medi-Cal benefits cannot be paid without proof of payment/description of the denial from Medicare for dates of service from April 1, 2015, through June 30, 2016. These claims will be automatically reprocessed via an Erroneous Payment Correction (EPC). No action is required of providers.

Until further notice, providers should wait to resubmit medical transportation claims denied with RAD code 0640: Recipient is not eligible for Medi-Cal benefits without complete denial of coverage from the Medicare Health Maintenance Organization (HMO), Competitive Medical Plan (CMP) or Health Care Prepayment Plan (HCPP). Medi-Cal is not obligated for plan services when the recipient chooses not to go to a plan provider. The Department of Health Care Services (DHCS) will publish a NewsFlash announcement once this issue is resolved.

Providers are encouraged to check the Medi-Cal website regularly for updates regarding this issue.